10.30.2010

It's Not Over Yet: South Africa

Impact:
South Africa is often times considered the role-model for Africa. With a good economy and a stable government, South Africa is looked upon as having made the right moves towards emerging out of poverty and corruption. However, in this gem of a country, the HIV/AIDS epidemic had made a huge impact.

Number of deaths due to AIDS - World Health Organization
South Africa is home to the most people living with HIV/AIDS in the world – around 5.7 million to be exact. Along with having the most people living with AIDS in the country, South Africa also has the highest number of AIDS related deaths in the world with over 700,000 deaths in previous years. As time has gone on, the rate of death as a result of AIDS has only been increasing, which can be seen in the graph to the right. The prevalence rate is also extremely high with over 18% of the adult population being infected; however, in various provinces the prevalence can be as high as nearly 40%

Children
HIV in South Africa has had a significant impact on children in multiple ways. Much like in Swaziland, there are many children orphaned from AIDS in South Africa. Statistics show that there are somewhere between 1.5 and 3 million orphans as a result of AIDS. The AIDS epidemic has also created half of the country’s total number of orphans. Orphans are then either taken in by institutions where they are given essential care and support or they are left to care for the rest of their families or have to result to becoming street children. Because of this, many children end up losing their childhood and are forced to grow up extremely fast.
Children are also significantly affected by AIDS because mother-to-child transmission is a large problem in South Africa. The MTCT rate is at 11% and there were nearly 300,000 children in 2007 under the age of 15 living with HIV in South Africa. In an effort to lower the prevalence of HIV among children and to lower the transmission rate between mothers and children, South Africa implemented a treatment plan that gives women Antiretroviral therapy (ART) if their CD4 counts drops below 350 and when they are in their 14th week of pregnancy. By 2011, hopes are that the National Strategic Plan will make it so 95% of HIV positive pregnant women will receive treatment for MTCT.

Sex Workers and Truck Drivers
Sex workers and truck drivers play a significant role in the spread of HIV throughout the country. In the sex industry, women are often discouraged from using condoms; thus, increasing the chances of infecting their clients with HIV or increasing their own chances of becoming infected. Much like those in the sex industry, truck drivers are important to target in prevention campaigns if HIV is to be taken under control in South Africa. Truck drivers, who are often on road trips for an extended period of time, will often participate in high risk sex along their routes. According to the World Health Organization, the prevalence of HIV among the sex worker population is nearly 70% (2004) in non-urban areas and 50% in urban areas (2000). In the truck driver population, the prevalence is 56% (1998), although recent statistics fail to calculate the prevalence rate in current years. It is obvious that these populations are critical to target in prevention campaigns if HIV is to be controlled.

Tuberculosis and AIDS
South Africa has one of the highest co-infection rates of HIV/AIDS and Tuberculosis. WHO estimates that in urban areas, the prevalence rate for HIV in TB patients was nearly 70% in 2002 and in non-urban areas in 2003 it was nearly 60%. Doctors Without Borders says that an increasing number of people are also becoming infected with drug-resistant TB. Although South Africa accounts for just .7% of the world’s population, it hosts 28% of those infected with both HIV and TB. The leading cause of death among AIDS patients in South Africa is Tuberculosis, so it is evident why these two health issues need to be addressed.  

The Treatment Gap
Many of those who are HIV positive in South Africa are in desperate need of antiretroviral therapy. According to WHO, only 37% of those in need of treatment are receiving it. The large gap between those in need of ARTs and those who are actually receiving them is largely due to the widespread denial of the causes and treatment of AIDS that the government has

Half-Time: Doctors Without Borders' Campaign for AIDS Funding
In a new worrisome trend, international donors are beginning to cut off, cap, or stop their funding for HIV treatment and ARVs. Some of these organizations include PEPFAR, the World BankUNITAID, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. The problem with reducing or removing funding for HIV treatment is that AIDS isn't gone! If anything, spending on HIV treatment should be increasing because it has been proven to increase the lifespans of those living with HIV. Antiretroviral drugs (ARVs) have even come down in cost which allows them to be a more feasible option for many HIV patients around the world. Doctors Without Borders found that,
"In the world today over 9 million people in need of urgent HIV treatment do not have access to this life-saving care, but only 1 in 3 have access to treatment.  In 2009, 2 million people died of AIDS and HIV-related diseases and close to 60% of those in need of treatment are still not getting it." 
During the World Cup this summer, Doctors Without Borders (MSF) created their HALFTIME! Campaign to raise awareness on the growing treatment gap that is resulting from lack of funding for HIV treatment programs. They found that during the 31 days of the World Cup, 160,000 would die from AIDS worldwide with 22,000 of them being from South Africa. Doctors Without Borders had 6 teams comprised of survivors from AIDS thanks to ARV treatment play soccer matches to raise awareness to the importance that ARVs have on the control the AIDS epidemic. This, I found, was a creative and effective way to speak out about the importance of HIV funding and to remind world's leaders that they cannot turn their back of AIDS. 

The Roadblock: Misinformed Government Officials
South Africa has had far too many leaders and government officials that have either denied AIDS or that have had ridiculous misconceptions about HIV/AIDS. Thabo Mbeki, South Africa's president from 1999-2008, was one such government official who was in denial about AIDS. Mbeki firmly believed that HIV did not cause AIDS, rather that AIDS was a result of poverty and bad nutrition. He also argued that ARVs were the West's way to make money off of Africa and that ARVs did not help treat AIDS. Instead, his solution to treating HIV was to eat beetroot and garlic and to take a locally developed drug called Virodene that was a supposed cure for HIV; however, it was later discovered that this drug was not a cure and that it was in fact carcinogenic. Research has found that as a result of Mbeki's foot dragging, denial that ARVs are indeed helpful in the treatment of AIDS, and refusal to implement HIV programs, that 330,000 people needlessly died while he was president and 35,000 HIV positive babies were born

Looking Ahead
AIDS has had an undeniable impact on South Africa. In order for the AIDS epidemic to be controlled in South Africa, more HIV treatment programs need to be implemented and more awareness campaigns need to be directed toward the 15-40 age group, sex workers, and truck drivers so that they are properly informed on the causes, prevention and treatment of HIV/AIDS. Furthermore, the misconceptions that many South Africans and government officials have about AIDS need to be cleared up which can be achieved through large-scale awareness campaigns. Although Thabo Mbeki is no longer President of South Africa, the current President, Jacob Zuma, still has misconceptions about HIV. Although he does not deny that ARVs help treat HIV or that HIV does indeed lead to AIDS, he does however have many other faults. For example, in his rape trial prior to him becoming president he stated that he did not use a condom when he had sex with the women who charged him with rape and that afterward, in order to reduce the risk of contracting HIV, he took a shower which he claimed "would minimize the risk of contracting the disease". AIDS activists were outraged by these findings and statements and said that they had the potential to destroy years of hard work to clear such misconceptions about HIV. With misconceptions like these still floating around, it will be difficult to get the AIDS epidemic under control in South Africa. I hope that South Africans can begin to benefit from more easily accessible HIV treatment in the near future. Until then, the fight against AIDS in the hot-zone of South Africa will not be a easy task.

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